title: Effects of nebivolol on aortic compliance in patients with diabetes and maximal renin angiotensin system blockade: the EFFORT study.
abstract: The beneficial effects of nebivolol on arterial stiffness and endothelial dysfunction are well documented in untreated hypertensive patients and differ from nonvasodilatory β-blockers. This study tests the hypothesis that the addition of nebivolol in predominantly African American patients with type 2 diabetes already receiving maximally tolerated doses of renin-angiotensin system (RAS) blockers will further improve large artery compliance. Patients with type 2 diabetes and hypertension on maximal RAS blockade (n=70) were randomized to nebivolol or metoprolol succinate daily. Doses were titrated until systolic blood pressure (SBP) was <130 mm Hg. Radial artery applanation tonometry and pulse wave velocity (PWV) analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits at intervals during a 6-month period. Both metoprolol succinate and nebivolol groups demonstrated reductions in brachial SBP (-8.2±4.3 mm Hg [P=.01] and -7.8±3.7 [P=.002], respectively) and aortic DBP (-2.4±1.8 [P=.039] and -4.0±2.9 mm Hg [P=.013], respectively). Aortic SBP decreased in the nebivolol group only (125.3±8 to 121.6±8.2, P=.025). There were no between group differences in aortic SBP, DBP, augmentation index, or PWV reduction. A significant increase in hemoglobin A1c was observed only in the metoprolol group. In patients with well-controlled type 2 diabetes and hypertension treated with maximally tolerated RAS blockade, nebivolol does not offer significant reductions in aortic BP over metoprolol succinate but maintains a stable metabolic profile.
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.forename: Raymond
authors.initials: R
authors.lastname: Oliva
authors.forename: Rigas
authors.initials: R
authors.lastname: Kalaitzidis
authors.forename: Colleen
authors.initials: C
authors.lastname: Flynn
authors.forename: Ivana
authors.initials: I
authors.lastname: Lazich
authors.forename: Carrie
authors.initials: C
authors.lastname: Schlaffer
authors.forename: George
authors.initials: G
authors.lastname: Bakris
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D001741:Black or African American; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D001011:Aorta / Q000187:drug effects / Q000502:physiology*; D001578:Benzopyrans / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D004983:Ethanolamines / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D017706:Lisinopril / Q000494:pharmacology / Q000627:therapeutic use; D019808:Losartan / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008790:Metoprolol / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D000068577:Nebivolol; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001578:Benzopyrans; D004983:Ethanolamines; D000068577:Nebivolol; D017706:Lisinopril; D008790:Metoprolol; D019808:Losartan